Heartburn or heart attack: When to worry

You’ve just eaten a big meal and feel a burning sensation in your chest. Heartburn, right? Probably, but there’s a chance the chest pain is caused by reduced blood flow to your heart (angina) or an actual heart attack.

Heartburn, angina and heart attack may feel very much alike. Even experienced doctors can’t always tell the difference from your medical history and a physical exam. That’s why, if you go to the emergency room because of chest pain, you’ll immediately have tests to rule out a heart attack.

If you have persistent chest pain and you aren’t sure it’s heartburn, call 911 or emergency medical help.

Call your health care provider if you had an episode of unexplained chest pain that went away within a few hours and you did not seek medical attention. Both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain doesn’t have to last a long time to be a warning sign.

Heartburn is discomfort or actual pain caused by digestive acid moving into the tube that carries swallowed food to your stomach (esophagus).

Typical features of heartburn include:

• A burning sensation in the chest that may also involve the upper abdomen
• Usually occurs after eating or while lying down or bending over
• May awaken you from sleep, especially if you have eaten within two hours of going to bed
• Is usually relieved by antacids
• May be accompanied by a sour taste in your mouth — especially when you’re lying down
• May be accompanied by a small amount of stomach contents rising up into the back of your throat (regurgitation)

The “textbook” heart attack involves sudden, crushing chest pain and difficulty breathing, often brought on by exertion. Many heart attacks don’t happen that way, though. The signs and symptoms of a heart attack vary greatly from person to person. Heartburn itself can accompany other symptoms of heart attack.

Typical heart attack signs and symptoms include:

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
• Nausea, indigestion, heartburn or abdominal pain
• Essoufflement
• Cold sweat
• Fatigue
• Lightheadedness or sudden dizziness

The most common symptom of heart attack for both men and women is chest pain or discomfort. But women are more likely than men to experience some of the other symptoms, such as jaw or back pain, shortness of breath, and nausea or vomiting. Heart problems are more common among people who have high blood pressure, diabetes or high cholesterol. Smoking and being overweight are other risk factors.

A muscle spasm in your esophagus may cause chest pain similar to that of a heart attack. The pain of a gallbladder attack also can spread to your chest. With gallbladder disease, you may notice nausea and an intense, steady ache in the upper middle or upper right abdomen — especially after a fatty meal. The pain may shift to your shoulders, neck or arms. Again, if you are not sure seek medical attention immediately.